Doctors reflect on coronavirus’ outsized toll on communities of color

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When cases of COVID-19 were ramping up at the start of the pandemic in the U.S., Americans thought everyone was susceptible to the virus, no matter their age, gender, race or location.

But it turns out, coronavirus is disproportionately affecting people of color across the U.S. in terms of testing, treatment, and death tolls. These communities have long struggled with other ailments and health care issues. 

KCRW discusses this — and what can be done to improve health outcomes — with Dr. Deborah Prothrow-Stith , Dean and Professor of Medicine for the College of Medicine at Charles R. Drew University; and Dr. Oliver T. Brooks , President of the National Medical Association and Chief Medical Officer at Watts Healthcare Corporation.

KCRW: How is race a factor in terms of testing and treating African Americans with the novel coronavirus?

“As relates to testing, there may be reluctance for some African Americans to even go to a testing station,” says Dr. Brooks. 

He explains that’s because African Americans distrust the health care system, feel they must exhibit all the symptoms to warrant a test, and must be believed by doctors. 

“As it relates to treatment … a lot of African Americans are not necessarily admitted when they go to the E.R. with overt symptoms and empiric findings of illness like low oxygen levels or shortness of breath,” he says. “So with the general mistrust and maltreatment in the past and what has been seen in the present, there is somewhat of a reluctance to actually access care, testing, or treatment.”

Dr. Oliver T. Brooks is the head of the National Medical Association, the largest professional group for black doctors. Photo credit: courtesy Dr. Brooks / National Medical Association.

Why are African Americans not getting treated if they’re going to the hospital with symptoms or testing positive for the virus?

Dr. Brooks: “There's a concept called ‘implicit bias,’ and basically it's institutional racism. When they walk into the hospital, they’re not necessarily viewed as a 52-year-old African American male with shortness of breath and a temperature of 102. They're viewed as, ‘Here's a black man coming in and needing something. I'm not sure why he’s here, but we'll deal with him’ ... Essentially, it comes from 400 years of racism.”

There are reports of African Americans having underlying conditions that make the coronavirus worse. What about that?

Dr. Prothrow-Stith: “In some ways, it's not a surprise that the COVID virus is affecting communities that have more high blood pressure, more heart disease, more diabetes. And it's affecting those communities in a more difficult way.

And then you add into that many people from black and brown communities are doing essential jobs that are in congested settings, like service jobs. And therefore, their exposure has been higher. So you add all that up and you get this disparity. There's an old saying in the black community, ‘When America gets a cold, the black community gets pneumonia.’”

What does that look like on the ground? If a black patient with pneumonia goes to the E.R. and is treated by a white doctor there, what sort of treatment will they see?

Dr. Prothrow-Stith: “We know that African Americans are more likely to get their legs amputated. We know that they are less likely to get pain medicine. 

One of the seminal studies two decades ago showed that African Americans showing up in the hospital with the same symptoms and the same level of insurance for pain in their chest were less likely to get a full workup, catheterization, and treatment for heart disease. 

We know African Americans are less likely to get on the transplantation list. It just goes on and on. COVID is, I think, an example of this problem to the broader American network.”

Dr. Brooks: “Piggybacking on what Dr. Protherow-Stith said, sickle-cell patients were less likely to get pain medications, though it's a very painful condition, because they were thought to be drug-seeking. … 

Often blacks are not included in clinical trials. So there's not the confidence that some of the treatments or medications or other modalities used to heal were even tested on us. 

… One in eight in this country are black in terms of population, but only one in 15 physicians are black. And there are studies that show when black physicians treat black patients, the black patients have better outcomes. There was a study that showed better outcomes from heart disease in Oakland when black patients, black males, were treated by a black doctor versus a white doctor. And so the feeling is that you may go past that implicit bias.”

Dr. Deborah Prothrow-Stith
says implicit bias in medicine isn’t just limited to African Americans — it’s affecting Latinos and other people of color. Photo credit: Charles R. Drew University.

KCRW did a story about a coronavirus testing site at Charles R. Drew University (CDU), which was going to gather demographic data at the site. Does that data speak to these biases?

Dr. Prothrow-Stith: “We are testing a good number of both black and brown people, many of them living in the areas right around Watts and Compton. Some of those trust issues do seem to be addressed by having a site in the area and having CDU staff working at that site. 

We've tested over 12,000 people. … We are finding that it's not just an African American problem. It's also a Latino problem. Black and brown people in the United States have similar experiences when it comes to being marginalized and under-resourced and experiencing racism.”

Dr. Brooks, you're the president of the country's largest professional organization representing black doctors. You’re calling on federal health agencies to study the role of bias in testing and treatment. Have you heard from any federal health agencies that they're planning to do so?

Dr. Brooks: “Yes and no. The CDC administrator, Robert Redfield, did assure me and others on a call with the White House task force that they would be providing race and ethnic data from the CDC. That in and of itself is just providing data. As it relates to actually doing research and studies and dedicating research dollars in that direction, no.”

Dr. Prothrow-Stith: “The training of black and brown physicians and nurses … this is something that I think is worth underscoring. We are in a physician shortage generally. And when you look at those providers that look like the patients they're serving in communities like Watts and Compton and South LA, we just don't have enough. 

In South LA, in what's called SPA 6 (service planning area six for the county), there are a million people. And Charles Drew [University] is trying to start a full four-year medical school on campus. Because you take a place like Boston where there are four medical schools and only 600,000 people, you realize that we've got a shortage. … We are under-resourced in South LA when it comes to physicians and nurses, especially those who look like the people we're serving.”

— Written by Matt Guilhem, produced by Jenna Kagel